MCP servercom.medigami/mcp

Find all access pathways for a GLP-1 drug (Ozempic, Wegovy, Mounjaro, Zepbound) given patient eligibility factors. Ranks pathways by monthly cost, flags prior-authorization rules a

[Taxonomy VII.120 — baseline response (public data only)] Generate component arguments for an appeal letter: medical-necessity, contract, policy. WHEN TO USE: User has a denied cl

[Taxonomy VII.129 — baseline response (public data only)] Find the correct escalation path for a denied claim (internal appeal → external review → DOI). WHEN TO USE: User needs to

[Taxonomy E.25 — delegates to estimate_appeal_success] Given a denial, predict the probability of a successful appeal. Returns probability with 95% CI, sample size, and recommended

Scan multiple medical bills in one call. Returns per-bill anomaly lists + total recovery estimate across the batch. Input is a list of {bill_text, provider?, insurer?} items (max 1

[Taxonomy X.179 — baseline response (public data only)] Predict risk that a planned service will trigger an unexpected large bill. WHEN TO USE: User planning a service and wants t

[Taxonomy III.51 — baseline response (public data only)] Delta between billed charge and payer-allowed amount for a claim line. WHEN TO USE: User wants to understand what a servic

[Taxonomy C.16 — delegates to scan_bill_for_errors] Detect CPT unbundling (billing components of a procedure separately to inflate the claim). Uses the CMS NCCI edits plus payer-sp

[Taxonomy III.39 — baseline response (public data only)] Estimate a fair cash price for a service in a given region (no-insurance path). WHEN TO USE: Uninsured/self-pay user wants

[Taxonomy H.41 — baseline response (public data only)] For a given service + patient plan, determine whether cash-pay + charity-care beats insurance billing. WHEN TO USE: User is

[Taxonomy C.14 — delegates to scan_bill_for_errors] Detect internal contradictions in a claim: time mismatches, mutually exclusive codes, missing required fields, patient-gender/pr

[Taxonomy IV.75 — baseline response (public data only)] Detect duplicated service lines within a single claim. WHEN TO USE: Caller is building or validating a claim payload before

[Taxonomy VII.128 — baseline response (public data only)] Generate a rebuttal to a payer's denial rationale point-by-point. WHEN TO USE: User has a denied claim and wants to appea

[Taxonomy VII.132 — baseline response (public data only)] Build a claim reconsideration request (lighter-weight than a formal appeal). WHEN TO USE: User has a denied claim and wan

[Taxonomy II.25 — baseline response (public data only)] Check a set of CPT codes against NCCI bundling rules (distinct from modifier-based unbundling). WHEN TO USE: User asks abou

[Taxonomy A.5 — delegates to scan_bill_for_errors] Detect CPT unbundling, mutually exclusive code pairs, and NCCI edit violations in a set of codes. Implemented by the bill scanner

[Taxonomy III.49 — baseline response (public data only)] Simulate member coinsurance exposure across plan-design variants. WHEN TO USE: User wants to model their coinsurance share

[Taxonomy III.50 — baseline response (public data only)] Model member copay for a service by plan-design class. WHEN TO USE: User wants the typical copay for a service type (prima

[Taxonomy II.21 — baseline response (public data only)] For a given CPT, surface the ICD-10 codes typically paired with it for medical-necessity support. WHEN TO USE: User has a C

Decode a CARC (Claim Adjustment Reason Code) denial code into plain English. Returns meaning, category, whether it's typically reversible on appeal, and appeal guidance. Source: pu

[Taxonomy III.48 — baseline response (public data only)] Estimate how a planned service will draw against the member's deductible. WHEN TO USE: User wants to know how a specific c

[Taxonomy VII.131 — baseline response (public data only)] Explain a CARC/RARC denial code in plain language with common causes. WHEN TO USE: User asks 'what does CO-16 mean' or si

[Taxonomy VI.106 — baseline response (public data only)] Classify a denial letter or remittance advice into normalized denial-reason categories. WHEN TO USE: User or caller wants

[Taxonomy VII.121 — baseline response (public data only)] Build a denial-response package tailored to the denial reason code. WHEN TO USE: User has a denied claim and wants to app

[Taxonomy VII.123 — baseline response (public data only)] Assemble a complete dispute case file including claim, denial, evidence, and timeline. WHEN TO USE: User has a denied cla

Probability an appeal will be approved, derived from outcome-labeled data weighted by label provenance (IRO determinations, EOB reversals, physician confirmations). Returns probabi

[Taxonomy VII.124 — baseline response (public data only)] Generate an evidence package supporting a claim or appeal (references, studies, policies). WHEN TO USE: User has a denied

Human-readable rationale for an appeal probability. Returns {probability, tier, recommended_posture, rationale, expected_days_to_resolution, tracking_id} grounded in aggregate outc

[Taxonomy B.8 — delegates to benchmark_payer_rate] Fair-market price distribution for a service: DP-noised percentiles (p10, p25, p50, p75, p90) for the given CPT in a ZIP3 region.

[Taxonomy X.181 — baseline response (public data only)] Find applicable financial-assistance programs (hospital charity, 340B, state, pharma). WHEN TO USE: User needs help paying

[Taxonomy X.176 — delegates to financial_risk_exposure_model] Model a member's financial exposure. Alias of financial_risk_exposure_model. WHEN TO USE: User is planning for a medi

[Taxonomy H.42 — baseline response (public data only)] Quantify a patient's financial exposure to medical-debt risk given current plan, health status, and historical claim volatili

Format an LLM-citable reference to a previously-attested Medigami MCP response. Input: either the full signed envelope that an earlier attested tool returned, OR just a tracking_id

DEPRECATED ALIAS of format_citation — kept for backward compatibility with v0.1.7 clients. New code should call format_citation directly. WHEN TO USE: Reference lookups: individua

Generate a legally-grounded insurance appeal letter for a denied claim. Returns the letter as a template with [PATIENT NAME] and [PROVIDER NAME] placeholders (structured-only PHI p

[Taxonomy F.28 — delegates to generate_appeal_letter] [Taxonomy alias] Generate a state-specific insurance appeal letter with UPL-safe disclaimers for 19 US states. Same impl as ge

External-review filing deadline for a state + the date of the FINAL adverse determination. Returns the deadline date, the statutory window label + citation, and whether the exact s

Where and how to file an external review for a given state — the venue name, filing channel (portal/mail/fax), portal URL, and whether expedited review is available. Free, no auth.

[Taxonomy X.183 — baseline response (public data only)] Forecast a household's annual healthcare spend based on plan + utilization. WHEN TO USE: User planning annual healthcare sp

[Taxonomy II.22 — baseline response (public data only)] For a given ICD-10, surface the CPT codes typically billed for that diagnosis. WHEN TO USE: User has an ICD-10 diagnosis an

[Taxonomy III.46 — baseline response (public data only)] Inflation-adjusted price comparison across years for a CPT. WHEN TO USE: User has a historical dollar amount and wants it

[Taxonomy H.39 — baseline response (public data only)] Given a patient's historical claim patterns, rank available insurance plans by expected annual cost. WHEN TO USE: User is pl

[Taxonomy F.31 — baseline response (public data only)] Parse an insurer's response letter or EOB into structured fields: denial reason codes, appeal rights, deadlines, next-step re

[Taxonomy X.185 — baseline response (public data only)] Recommend insurance-plan selections to maximize value given projected utilization. WHEN TO USE: User is planning for a medi

Look up a CPT or HCPCS-J code or search by keyword. Covers the most common outpatient billing codes (E/M, preventive, lab, imaging, procedure, cardiology, therapy, behavioral, vacc

Look up an ICD-10-CM diagnosis code or search by keyword. Input is either an exact code (e.g. 'E11.21') or a free-text description phrase ('type 2 diabetes with nephropathy'). Retu

Look up a provider in the CMS NPPES National Provider Identifier registry. Accepts a 10-digit NPI number OR a provider name (optionally narrowed by 2-char state). Returns up to 20

Look up a NUCC provider taxonomy code (the specialty codes used on HIPAA transactions + NPI registrations) or search by keyword. Returns classification + type + optional specializa

[Taxonomy III.55 — baseline response (public data only)] Full DP-noised market price distribution for a CPT+region pair. WHEN TO USE: User wants to understand what a service typic

Given a prior scan_id, returns a prioritized action list: anomalies ranked by (expected overcharge x recovery probability), with the next steps to pursue each. Use after scan_bill_

[Taxonomy X.184 — baseline response (public data only)] Analyze a patient's medical spending over a period and surface optimization opportunities. WHEN TO USE: User is planning fo

Federal appeal-deadline window (ERISA §503 internal-appeal / ACA §2719 external-review / NSA IDR) for a plan type. Public regulator data, k-anonymity floored, not legal advice. WH

Historical external-review overturn rate published by the state regulator for the insurer you name, in a regulated venue (CA/NY/MD/NJ/MI/OH/NC). Returns one insurer's own rate — no

A hospital's own MRF-published negotiated rate for a CPT code (no billed-amount comparison — use medigami_roast for that). Public regulator data, k-anonymity floored, not legal adv

Compare a billed charge against a hospital's own MRF-published negotiated rate for a CPT code; returns the markup multiple. Public regulator data, k-anonymity floored, not legal ad

Generate a phone script the user can read when negotiating a medical bill directly with the provider. Combines DP-noised commercial rate benchmarks + the caller's household income

[Taxonomy F.30 — baseline response (public data only)] Given a bill + patient situation, generate a ranked negotiation strategy: hardship appeal, charity-care application, itemizat

Find the lowest-cost path for a prescription: generics, biosimilars, GoodRx coupons, manufacturer assistance, 90-day fills, and mail-order vs retail comparison. Returns ranked opti

[Taxonomy X.174 — baseline response (public data only)] Optimize out-of-pocket spend across a sequence of planned services. WHEN TO USE: User is planning for a medical expense, co

[Taxonomy III.53 — baseline response (public data only)] Flag services billed materially above market percentile thresholds. WHEN TO USE: User wants to understand what a service t

[Taxonomy X.182 — baseline response (public data only)] Explain why a specific charge appears on a bill in plain language. WHEN TO USE: User is planning for a medical expense, com

[Taxonomy H.38 — baseline response (public data only)] Given a patient's plan + predicted care needs, forecast annual out-of-pocket spend across expected claims. WHEN TO USE: User

[Taxonomy X.186 — baseline response (public data only)] Score a patient's financial risk exposure from planned or ongoing care. WHEN TO USE: User is planning for a medical expense

[Taxonomy VII.130 — baseline response (public data only)] Return payer-specific appeal templates known to perform well. WHEN TO USE: User has a denied claim and wants to appeal, o

[Taxonomy X.180 — baseline response (public data only)] Optimize a payment plan structure for a patient balance. WHEN TO USE: User has a balance and wants to structure a payment p

[Taxonomy III.52 — baseline response (public data only)] Detect service-line prices statistically anomalous versus market. WHEN TO USE: User wants to understand what a service typ

[Taxonomy III.56 — baseline response (public data only)] Detect claim-line outliers relative to a learned market distribution. WHEN TO USE: User wants to understand what a service

[Taxonomy III.58 — baseline response (public data only)] Recommend a reasonable price to propose to a provider for a service (self-pay or negotiation). WHEN TO USE: User wants to

[Taxonomy B.9 — baseline response (public data only)] Given a target price and a CPT+region, return how many standard deviations above/below the market the target sits, plus confid

[Taxonomy X.177 — baseline response (public data only)] Rank a set of procedures by affordability for a given member. WHEN TO USE: User is planning for a medical expense, comparin

[Taxonomy III.57 — baseline response (public data only)] Decompose the cost of a procedure into component services + facility + professional fees. WHEN TO USE: User wants to under

[Taxonomy III.43 — baseline response (public data only)] Regional price benchmark for a CPT at state/metro/ZIP3 granularity. WHEN TO USE: User wants to understand what a service t

[Taxonomy A.1 — baseline response (public data only)] Unified code resolver — free-form query or clinical description → ranked ICD-10-CM, CPT, and HCPCS codes with confidence score

End-to-end denial resolution: returns appeal probability + confidence interval + a drafted letter template grounded in aggregate outcome data + plan-context flags (ERISA, restricti

Scan a medical bill or EOB text for errors: duplicate charges, CPT unbundling, upcoding, facility-fee overcharges. Returns flagged anomalies with estimated dollar impact and a tota

[Taxonomy F.32 — baseline response (public data only)] For a disputed bill, compute the optimal settlement target price balancing probability of acceptance against amount saved. W

[Taxonomy III.44 — baseline response (public data only)] Price benchmark for a CPT within a specific provider specialty. WHEN TO USE: User wants to understand what a service typic

Submit a medical-claim denial letter to the Medigami Denial Common Crawl (public aggregate dataset). Consent-gated — caller must pass consent=true to attest the submission is volun

[Taxonomy VII.135 — baseline response (public data only)] Select optimal supporting documents for an appeal from an available document pool. WHEN TO USE: User is preparing an appe

[Taxonomy X.178 — baseline response (public data only)] Compare expected costs across treatment alternatives for a condition. WHEN TO USE: User is planning for a medical expense,

[Taxonomy II.26 — delegates to scan_bill_for_errors] Detect CPT unbundling patterns in a claim. Alias of scan_bill_for_errors. WHEN TO USE: User asks about medical codes: what a C

Verify an Ed25519-signed Medigami MCP response envelope — confirm a medical-bill / appeal / denial / rate answer came from Medigami and hasn't been tampered with. Input: the signed

Validate the format + checksum of a DEA registration number (format: [A-Z][A-Z9][0-9]{7}; public checksum algorithm). Useful as a sanity check on a DEA number you were given (e.g.

DEPRECATED ALIAS of verify_attestation — kept for backward compatibility with v0.1.7 clients. New code should call verify_attestation directly. WHEN TO USE: Reference lookups: ind

Subscribe to an appeal outcome by tracking_id. Blocks up to `timeout_seconds` (default 300). Returns the outcome payload as soon as it's recorded, or {status: 'timeout'} if nothing

Subscribe to a claim denial event for a given scan_id. Blocks up to `timeout_seconds`. Returns {status: 'denied', ...} as soon as the payer marks the claim denied in claim_status_h

[Taxonomy III.41 — baseline response (public data only)] Report price variance for a CPT across ZIP3 regions with DP noise. WHEN TO USE: User wants to understand what a service ty